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Canaan Community Space
Community Needs Survey
As Canaan moves toward the establishment of a community center in town, we want to gather data from residents and taxpayers as to what that means to you. Your feedback is valuable!
*
1.
About how long have you lived in Canaan
(Required.)
0-5 years
5-10 years
10-20 years
20-30 years
30-60 years
60+ years
Other (please specify)
*
2.
Are you a registered voter in the town of Canaan, NH
(Required.)
Yes
No
Unsure / Don’t know
*
3.
Do you think that the town of Canaan would benefit from a community center?
(Required.)
Definitely would
Probably would
Probably would not
Definitely would not
*
4.
What type of community center does Canaan need? Please be as specific as possible.
(Required.)
5.
Are you a member of any groups, organizations, or clubs in the community?
Yes
No
Please list all groups/clubs:
6.
What do you like best about Canaan?
7.
Do you know anyone in Canaan who doesn't have the support they need? For example, a neighbor who is lonely and would like conversation, or someone who is sick and doesn't have help.
Yes
No
8.
Which of the following categories best describes your employment status?
Employed, working full-time
Employed, working part-time
Not employed, looking for work
Not employed, NOT looking for work
Retired
Disabled, not able to work
Other (please specify)
9.
Which category includes your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
10.
How many children age 17 and younger live in the household?
None
1
2
3
4
More than 4
11.
Would you like to include your name and/or contact information?
Name
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Country
Email Address
Phone Number
